Provider Demographics
NPI:1447204011
Name:GLOVER CLINIC
Entity Type:Organization
Organization Name:GLOVER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT GLOVER CLINIC
Authorized Official - Prefix:
Authorized Official - First Name:HOMAYOON
Authorized Official - Middle Name:
Authorized Official - Last Name:PASDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-259-8585
Mailing Address - Street 1:2100 KEYSTONE AVENUE
Mailing Address - Street 2:STE 400
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 KEYSTONE AVENUE
Practice Address - Street 2:STE 400
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026
Practice Address - Country:US
Practice Address - Phone:610-259-8585
Practice Address - Fax:610-259-3679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030384L208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0643181Medicaid
039389Medicare ID - Type Unspecified
PA0643181Medicaid